1346344355 NPI number — EDWARD A MATTHEWS D.O.

Table of content: EDWARD A MATTHEWS D.O. (NPI 1346344355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346344355 NPI number — EDWARD A MATTHEWS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATTHEWS
Provider First Name:
EDWARD
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346344355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9006
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31908-9006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-323-5552
Provider Business Mailing Address Fax Number:
706-323-3066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 MANCHESTER EXPY
Provider Second Line Business Practice Location Address:
STE 2001
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31904-6802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-323-5552
Provider Business Practice Location Address Fax Number:
706-323-3066
Provider Enumeration Date:
09/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  34896 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: DO376 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000471633 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 167594 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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